Abstract 13130: The Blood Lactate Clearance Following Extracorporeal Cardiopulmonary Resuscitation for Pediatric Patients With In-Hospital Cardiac Arrest
Purpose: Post-cardiac arrest care after return of spontaneous circulation (ROSC) is important to improve the likelihood of patient survival. The blood lactate level has been recommended for monitoring the organ perfusion in the early-goal-direct-therapy for post-arrest care. We hypothesis that the lactate level had prognostic value in pediatric patients received extracorporeal cardiopulmonary resuscitation (ECPR) and try to identify the suitable target lactate level in the post-ECPR patients.
Methods: The pediatric patients who received extracorporeal membrane oxygenation (ECMO) during active cardiopulmonary resuscitation from 1999 to 2010 were included in the retrospective study. The venous-arterial(V-A) ECMO were applied in all patients. The survival outcome and neurological outcome were studied and good neurological outcome was defined as Pediatric Cerebral Performance Categories (PCPC) 1, 2, and 3.
Results: We identified 62 ECPR events. The survival rate to hospital discharge was 50% (31/62). Among the 31 survivors, 26(84%) of them had good neurological outcomes, making the good neurological outcome survival 42%. The duration of cardiopulmonary resuscitation (CPR) was 40+/-17 minutes in the survivors and 52+/- 43 minutes in the non-survivors (p=N.S). The non-survivors had higher peak, 12-hours, 24-hours lactate level (17.0+/-7.1 vs 12.0+/-4.3 mmol/L, p = 0.001, 9.8+/-6.0 vs 5.8+/-4.1 mmol/L, p=0.004, 6.4+/-4.7 vs 3.5+/-3 mmol/L, p=0.003, respectively ).Clearance of lactate was higher in the survivors at 24 hours post ECPR (-68+/-23% vs -53+/-30%, p=0.045). Using the lactate level at 24 hours after ECPR, the discriminatory value was highest by setting the lactate <3mmol/L for good neurological outcome survival (odds ratio =6.3, 95% C.I.=2.0-20.3).
Conclusions: In this pediatric in-hospital ECPR cohort, CPR duration was not associated with survival outcome. The non-survivors had higher lactate level and lower clearance in the 24 hours post-ECPR. Targeting lactate level <3mmol/L at 24 hours post-ECPR might be a reasonable goal for post-arrest care.
- © 2011 by American Heart Association, Inc.